Keaton A. Fletcher

Cognitive Aids Design Suggestions for the Medical Field

The high task and emotional demands of healthcare drain individual cognitive, affective, and physical resources. When these resources are depleted, practitioners are no longer able to vigilantly prevent system-based errors from occurring. Cognitive aids have frequently been suggested—and implemented—as a method to reduce the cognitive load associated with medical practice. Although cognitive aids can offer true benefits, haphazard implementation and overuse has led to “checklist fatigue.” To avoid this misuse and to maximize the benefits of these beneficial tools, we suggest that cognitive aids should be clear, easy to use, adaptable to the context, properly trained prior to implementation, pilot tested, and based on a needs-analysis. Furthermore, it appears that best practices for one type of cognitive aid in one context cannot necessarily be generalized to another. Therefore, this qualitative synthesis of the literature aims to provide three contextual factors to consider when addressing an issue with a cognitive aid. Designers and administrators need to consider the skill type that will be addressed, the physical, social, and organizational environment in which the aid will be utilized, as well as the experience level of the targeted users.

Measuring shared mental models in healthcare

Objective To review common qualitative and quantitative methods of measuring shared mental models appropriate for use in the healthcare setting. Background Shared mental models are the overlap of individuals’ set of knowledge and/or assumptions that act as the basis for understanding and decision making between individuals. Within healthcare, shared mental models facilitate effective teamwork and theorized to influence clinical decision making and performance. With the current rapid growth and expansion of healthcare teams, it is critical that we understand and correctly use shared mental model measurement methods assess optimal team performance. Unfortunately, agreement on the proper measurement of shared mental models within healthcare remains diffuse. Method This paper presents methods appropriate to measure shared mental models within healthcare. Results Multiple shared mental model measurement methods are discussed with regard to their utility within this setting, ease of use, and difficulties in deploying within the healthcare operational environment. For rigorous analysis of shared mental models, it is recommended that a combination of qualitative and quantitative analyses be employed. Conclusion There are multitude of shared mental model measurement methods that can be used in the healthcare domain; although there is no perfect solution for every situation. Researchers can utilize this article to determine the best approach for their needs.

Stress Outcomes of Four Types of Perceived Interruptions

Objective We sought to define and measure four types of perceived interruptions and to examine their relationships with stress outcomes. Background Interruptions have been defined and measured in a variety of inconsistent ways. No study has simultaneously examined the subjective experience of all types of interruptions. Method First, we provide a synthesized definition and model of interruptions that aligns interruptions along two qualities: origin and degree of multitasking. Second, we create and validate a self-report measure of these four types of perceived interruptions within two samples (working undergraduate students and working engineers). Last, we correlate this measure with self-reported psychological and physical stress outcomes. Results Our results support the four-factor model of interruptions. Results further support the link between each of the four types of interruptions (intrusions, breaks, distractions, and a specific type of ruminations, discrepancies) and stress outcomes. Specifically, results suggest that distractions explain a unique portion of variance in stress outcomes above and beyond the shared variance explained by intrusions, breaks, and discrepancies. Conclusion The synthesized four-factor model of interruptions is an adequate representation of the overall construct of interruptions. Further, perceived interruptions can be measured and are significantly related to stress outcomes. Application Measuring interruptions by observation can be intrusive and resource intensive. Additionally, some types of interruptions may be internal and therefore unobservable. Our survey measure offers a practical alternative method for practitioners and researchers interested in the outcomes of interruptions, especially stress outcomes.

An Initial Look at the Effects of Interruptions On Strain

Interruptions cost companies millions of dollars per year (Spira & Feintuch, 2005), in lost time and errors. Not only are interruptions detrimental to the immediate productivity of the worker, but they have been suggested to be significant workplace stressors. This study aims to determine whether it is the objective experience of an intrusion that results in strain, as some may suggest or whether, as the transactional model of stress would suggest, it is the perceptions of intrusions that result in strain. Overall, these findings suggest that it is the perception of intrusions, not necessarily the intrusion itself that results in strain. This indicates that when it comes to strain outcomes, it is the subjective, rather than the objective, experience of an intrusion that matters.

You’ve Got Mail: Examination of a Brief Online Email Training

Email is a primary method of communication for organizations, clients, and customers. The goal of this study is to examine the effects of a brief implementation of an online, less expensive, and less time consuming training session on writing a professional email. The findings suggest that conscientiousness predicts comfort with training which, in turn, predicts motivation to transfer. In other words, we found evidence to support the notion that individual characteristics can predict affective reactions which then predict utility reactions. The data, however, do not support the link between motivation to transfer and objective learning. Overall, practitioners and researchers need to measure and account for individual characteristics (e.g., conscientiousness) as well as affective (e.g., comfort with the training) and utility reactions (e.g., motivation to transfer) when evaluating training programs.

Medical Team Handoffs

Patient handoffs can look very different depending on the context, but regardless of the situation, they are a major vulnerability in patient care. The current regulations of resident work-hours have increased the frequency of handoffs, thereby increasing the risk to patients and the need to understand how to optimize the procedure. Moreover, the time pressure that many handoffs from one department to the next face pose a unique set of teamwork and communication challenges that need to be further explored. This expert panel will engage in discussion regarding the current state of medical team handoffs: in multiple contexts, how to use technology and the environment to increase their efficiency, and the role of human factors in creating a safer patient handoff.

Medical Team Handoffs Current and Future Directions

Patient handoffs can look very different depending on the context, but regardless of the situation, they are a major vulnerability in patient care. The current regulations of resident work-hours have increased the frequency of handoffs, thereby increasing the risk to patients and the need to understand how to optimize the procedure. Moreover, the time pressure that many handoffs from one department to the next face pose a unique set of teamwork and communication challenges that need to be further explored. This expert panel will engage in discussion regarding the current state of medical team handoffs: in multiple contexts, how to use technology and the environment to increase their efficiency, and the role of human factors in creating a safer patient handoff.